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This section of the website offers a "one stop" look
at most of the forms and publications on the Radioactive Materials Section portion of the
website. If you have any questions on completing these forms, please contact a
member of the Radioactive Materials Branch Staff for
assistance. Any new or updated forms or publications will have the ( NOTE:
Most of the
PDF ( NOTE: Look in the "Specific Licensing Section" for licensing guides and additional information which MUST be submitted with New License or Renewal Applications |
| Description of Form / Publication | File Format(s) | |
| FORMS | ||
| Application for Radioactive Materials License §(see below) |
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| Application for Accelerator License §(see below) |
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| Application for Amendment Form |
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| Preceptor Statement (Supplement A) for Medical Licenses §(see below) |
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Medical Event Reporting Form (EFFECTIVE March
01, 2008) |
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Dose to an Embryo/Fetus or Nursing Child Reporting Form (EFFECTIVE
March 01, 2008) |
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| Certificate of Disposition of Radioactive Materials (for termination/decommissioning) |
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| Financial Assurance Worksheet (UNDER CONSTRUCTION ) |
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| Radiographic and Reciprocity Location report |
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| Memorandum to All Licensees §(see below) |
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| Guidance on Change of Control of Ownership |
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| Occupational Dose Record for a Monitoring Period |
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| Guidance on Adding Board Certified Physician Authorized Users |
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| Notice to Employees (PDF ONLY - 8½" x 14" landscape format) |
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| Notice to Employees (EN ESPAÑOL) (PDF ONLY - 8½" x 14" landscape format) |
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2010 Low Level Radioactive
Waste Survey Form |
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PUBLICATIONS |
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| NRC Regulatory Guide 8.39 "Release of Patients Administered Radioactive Materials" |
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DOT EXEMPTIONS |
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| DOT - SP 11406 Exemption Instructions |
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| DOT - SP 11406 Form |
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| DOT- SP 10656 Exemption Instructions |
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| DOT -SP 10656 Form |
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| §NOTE: Look in the "Specific Licensing Section" for licensing guides and additional information which MUST be submitted with New License or Renewal Applications | ||
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| Last Modified :23 April 2012 |
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